内镜黏膜下剥离术对治疗早期胃癌的临床应用价值

摘要

目的 评估我院内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌(early gastric cancer,EGC)的有效性及临床应用价值.方法 对2006年11月-2013年2月内镜下发现的370例早期胃癌临床资料进行分析,共切除病变386个.其中212个是不典型增生,158个是黏膜内癌,16个是黏膜下癌.位于上段胃81个,中段胃122个,下段胃183个.内镜分型包括23个Ⅰ型,148个Ⅱa型,20个Ⅱb型,114个Ⅱc型,70个Ⅱa+Ⅱc型,11个Ⅱc+Ⅱa型.结果 完整性切除率及治愈性切除率分别为93.8％、90.9％.切除黏膜平均最大径是3.2 cm(1.5～8.0 cm).非治愈性切除35例,包括32例R1切除,3例Rx切除.术中出血2例,迟发出血2例.结论 对于在适应证范围内的早期癌,ESD能达到很高的完整切除率及治愈性切除率,是治疗EGC的有效方法.%Objective To evaluate the clinical efficiency and the value of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Methods Clinical data of 370 EGC patients were collected from Nov. 2006 to Feb. 2013. 386 lesions were resected under endoscopy, including 212 dysplasia, 158 cancer intramucosal and 16 cancer sub-mucosa. The location of tumors included 81 upper stomach, 122 middle stomach and 183 lower stomach. The endoscopic types were including: Ⅰ(23), Ⅱa(148), Ⅱb(20), Ⅱc(114), Ⅱa+Ⅱc(70) and Ⅱc+ Ⅱa(11). Results Enbloc or complete and curative resection rates were achieved 93. 8 % and 90. 9% . The average maximum tumor size was 3. 2 cm (1.5 ~ 8. 0 cm). 42 cases of non-curative resection included 32 cases of Rl resection, 3 cases of Rx resection, 2 cases occurred perforation during ESD procedures, 5 cases delayed bleeding. Conclusion ESD has been accepted as an effective treatment for EGCs with high ratio of enbloc or complete and curative resection.